Menu

8. Foot and Ankle MCQs

Practice Set 242 of 353

This practice set contains high-yield board review questions covering key concepts in 8. Foot and Ankle. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 4821

Topic: 8. Foot and Ankle

A 42-year-old male feels a pop in his heel while playing basketball. Examination reveals a positive Thompson test. He opts for nonoperative management. What is the most significant disadvantage of nonoperative management compared to operative repair of an acute Achilles tendon rupture?

. Higher risk of deep vein thrombosis
. Higher rate of wound complications
. Higher rate of re-rupture
. Decreased plantarflexion strength at 1 year
. Higher risk of sural nerve injury

Correct Answer & Explanation

. Higher rate of re-rupture

Explanation

Historically and in several studies, nonoperative management of Achilles tendon ruptures is associated with a higher re-rupture rate compared to operative repair, though functional outcomes are often similar with modern rehabilitation protocols.

Question 4822

Topic: 8. Foot and Ankle

A 24-year-old professional hockey player sustains an external rotation injury to his right ankle and has severe pain over the anterior inferior tibiofibular ligament (AITFL). Weight-bearing radiographs are normal. What is the most appropriate next step in management to rule out syndesmotic instability?

. External rotation stress radiographs
. Immediate syndesmotic screw fixation
. Non-weight bearing cast for 6 weeks
. Corticosteroid injection into the syndesmosis
. Bone scan

Correct Answer & Explanation

. External rotation stress radiographs

Explanation

In patients with suspected syndesmotic injuries and normal static radiographs, gravity or external rotation stress radiographs are necessary. This identifies dynamic syndesmotic instability requiring fixation.

Question 4823

Topic: 8. Foot and Ankle

A 34-year-old male ruptures his Achilles tendon while playing basketball. He is evaluating surgical versus nonoperative management. Based on recent Level I evidence regarding acute Achilles tendon ruptures, what should he be counseled regarding outcomes?

. Surgical repair provides a significantly lower re-rupture rate regardless of the postoperative rehabilitation protocol.
. Nonoperative management with rigid cast immobilization for 12 weeks is superior to early functional rehabilitation.
. Nonoperative management utilizing an early functional rehabilitation protocol yields re-rupture rates equivalent to surgical repair.
. Surgical repair has a lower incidence of sural nerve injury and wound healing complications.
. Surgical repair is mandated for optimal outcomes if the tendon gap is less than 1 cm in plantar flexion.

Correct Answer & Explanation

. Nonoperative management utilizing an early functional rehabilitation protocol yields re-rupture rates equivalent to surgical repair.

Explanation

Recent high-quality Level I evidence demonstrates that nonoperative management utilizing a strict, early functional rehabilitation protocol (incorporating early weight-bearing and ROM) results in re-rupture rates equivalent to surgical repair, while avoiding surgical wound and nerve complications.

Question 4824

Topic: 8. Foot and Ankle

A 3-week-old boy is undergoing serial casting for idiopathic clubfoot. The physician is preparing to correct the equinus deformity. According to the Ponseti method, what is the correct approach to addressing this deformity?

. Dorsiflexion of the first ray before correcting the heel varus.
. Percutaneous Achilles tenotomy after the heel is in valgus and anterior calcaneus is abducted.
. Gradual serial casting into pronation to unlock the subtalar joint.
. Immediate transfer of the anterior tibial tendon to the lateral cuneiform.
. Complete subtalar release if equinus persists after the first cast.

Correct Answer & Explanation

. Percutaneous Achilles tenotomy after the heel is in valgus and anterior calcaneus is abducted.

Explanation

In the Ponseti method, equinus is the final deformity to be corrected. It requires a percutaneous Achilles tenotomy in over 80% of cases, performed only after the cavus, adductus, and varus deformities have been fully corrected and the heel is in valgus.

Question 4825

Topic: 8. Foot and Ankle

A 14-year-old boy complains of recurrent ankle sprains and chronic lateral foot pain. Examination shows bilateral rigid flatfeet with peroneal spasticity. Oblique radiographs of the foot reveal an 'anteater nose' sign. Which of the following is the most appropriate initial treatment?

. Immediate resection of the coalition with fat pad interposition.
. Subtalar arthrodesis.
. Short leg cast immobilization for 4 to 6 weeks.
. Talonavicular arthrodesis.
. Medializing calcaneal osteotomy.

Correct Answer & Explanation

. Short leg cast immobilization for 4 to 6 weeks.

Explanation

The 'anteater nose' sign on an oblique radiograph is pathognomonic for a calcaneonavicular coalition. Initial management of symptomatic tarsal coalitions is nonoperative, utilizing a short leg cast or CAM boot to immobilize the joint and reduce inflammation.

Question 4826

Topic: 8. Foot and Ankle

A 14-year-old girl sustains an ankle injury. Radiographs show a fracture of the anterolateral distal tibial epiphysis. What is the primary mechanism of injury for this specific fracture?

. Plantarflexion and axial load
. Supination and inversion
. External rotation of the foot on the tibia
. Internal rotation of the foot on the tibia
. Direct valgus impact

Correct Answer & Explanation

. External rotation of the foot on the tibia

Explanation

A Tillaux fracture is an avulsion of the anterolateral distal tibial epiphysis. It occurs via external rotation of the foot, which places tension on the anterior inferior tibiofibular ligament.

Question 4827

Topic: 8. Foot and Ankle

A 14-year-old boy presents with a painful flatfoot and recurrent ankle sprains. Radiographs show a "C-sign" on the lateral view of the ankle. What is the best imaging modality to confirm the suspected diagnosis and assess its extent?

. Ultrasound
. Non-weight-bearing AP ankle radiograph
. CT scan of the foot and ankle
. MRI of the ankle
. Bone scan

Correct Answer & Explanation

. CT scan of the foot and ankle

Explanation

The "C-sign" on lateral plain radiographs indicates a talocalcaneal coalition. A CT scan is the gold standard to define the size, location, and osseous nature of tarsal coalitions.

Question 4828

Topic: 8. Foot and Ankle
A 4-year-old boy treated successfully with the Ponseti method for idiopathic clubfoot now presents with dynamic supination of the foot during the swing phase of gait. Passive range of motion of the foot and ankle is fully correctable. What is the standard surgical management for this relapse?
. Repeat percutaneous Achilles tenotomy
. Split anterior tibial tendon transfer (SPLATT)
. Full anterior tibial tendon transfer to the lateral (third) cuneiform
. Lateral column lengthening of the calcaneus
. Extensive posteromedial release

Correct Answer & Explanation

. Full anterior tibial tendon transfer to the lateral (third) cuneiform

Explanation

Dynamic supination during the swing phase in a patient treated with the Ponseti method is best managed by a full anterior tibial tendon transfer to the lateral (third) cuneiform. A split transfer (SPLATT) is generally contraindicated in idiopathic clubfoot as it can tether the foot.

Question 4829

Topic: 8. Foot and Ankle
A 3-year-old girl has been treated with a knee-ankle-foot orthosis (KAFO) for infantile Blount disease (Langenskiöld stage II) for the past 12 months. Radiographs demonstrate progressive bilateral tibia vara. What is the most appropriate next step in management?
. Observation
. Continue bracing until age 5
. Proximal tibial valgus osteotomy
. Lateral hemiepiphysiodesis
. Medial hemiepiphysiodesis

Correct Answer & Explanation

. Proximal tibial valgus osteotomy

Explanation

Infantile Blount disease that fails to improve after 12 months of bracing requires surgical intervention. Performing a proximal tibial valgus osteotomy by age 3 to 4 corrects the deformity and helps prevent irreversible medial physeal damage.

Question 4830

Topic: 8. Foot and Ankle

A 13-year-old boy presents with a rigid flatfoot and recurrent ankle sprains. A CT scan confirms a talocalcaneal coalition involving 25% of the posterior facet with no degenerative changes. He has failed 6 months of conservative management with casting and orthotics. What is the best definitive treatment?

. Observation
. Subtalar arthrodesis
. Talocalcaneal coalition resection with fat interposition
. Calcaneal lengthening osteotomy
. Triple arthrodesis

Correct Answer & Explanation

. Talocalcaneal coalition resection with fat interposition

Explanation

For a symptomatic talocalcaneal coalition involving less than 50% of the posterior facet without arthritic changes, surgical resection with interposition (fat or muscle) is the treatment of choice. Arthrodesis is reserved for larger coalitions (>50%) or cases with significant degenerative arthritis.

Question 4831

Topic: 8. Foot and Ankle

A 14-year-old boy presents with vague midfoot pain and a history of recurrent ankle sprains. Examination shows a rigid pes planovalgus foot with restricted subtalar motion. CT scan demonstrates a talocalcaneal coalition involving 60 percent of the middle facet, with degenerative changes in the posterior facet. What is the most appropriate definitive management?

. Resection of the coalition with interposition of an autologous fat graft
. Resection of the coalition with extensor digitorum brevis interposition
. Subtalar arthrodesis
. Triple arthrodesis
. Medial displacement calcaneal osteotomy

Correct Answer & Explanation

. Subtalar arthrodesis

Explanation

Resection of a talocalcaneal coalition is generally contraindicated if it involves greater than 50 percent of the middle facet or if degenerative changes are present in the posterior facet. Subtalar arthrodesis is the treatment of choice in this scenario.

Question 4832

Topic: 8. Foot and Ankle

A 13-year-old boy presents with frequent ankle sprains and a rigid, painful flatfoot. Radiographs reveal an elongated anterior process of the calcaneus approaching the navicular. What is the most appropriate initial management?

. Resection of the coalition with fat interposition
. Subtalar arthrodesis
. Triple arthrodesis
. Short leg cast or walking boot immobilization for 4-6 weeks
. Medializing calcaneal osteotomy

Correct Answer & Explanation

. Short leg cast or walking boot immobilization for 4-6 weeks

Explanation

The "anteater" sign is pathognomonic for a calcaneonavicular coalition. Initial management of a symptomatic tarsal coalition is nonoperative, consisting of immobilization (cast or boot) to reduce inflammation before considering surgical resection.

Question 4833

Topic: 8. Foot and Ankle

A 13-year-old boy presents with rigid flatfeet, frequent ankle sprains, and peroneal spasm. Radiographs show a 'C sign' on the lateral view. Which of the following coalitions is most likely present, and what is the best initial imaging to confirm it?

. Calcaneonavicular coalition; CT scan
. Talocalcaneal coalition; CT scan
. Calcaneocuboid coalition; MRI
. Talonavicular coalition; Ultrasound
. Talocalcaneal coalition; Bone scan

Correct Answer & Explanation

. Talocalcaneal coalition; CT scan

Explanation

The 'C sign' on a lateral radiograph is indicative of a talocalcaneal coalition, formed by the medial outline of the talar dome and the sustentaculum tali. Computed tomography (CT) is the gold standard for characterizing the size and extent of the coalition.

Question 4834

Topic: 8. Foot and Ankle

A 10-year-old boy with spastic diplegic cerebral palsy presents with a crouch gait. Physical examination reveals severe hamstring tightness and knee flexion contractures of 20 degrees. Which of the following interventions can worsen crouch gait if performed in isolation?

. Hamstring lengthening
. Achilles tendon lengthening
. Rectus femoris transfer
. Psoas lengthening
. Patellar tendon advancement

Correct Answer & Explanation

. Achilles tendon lengthening

Explanation

In patients with crouch gait, isolated Achilles tendon lengthening can drastically worsen the crouch by allowing unregulated tibial progression. This further weakens the plantarflexor-knee extension couple, increasing knee flexion during stance.

Question 4835

Topic: 8. Foot and Ankle

A 13-year-old boy presents with recurrent ankle sprains and a painful, rigid flatfoot. A lateral foot radiograph

reveals the classic "anteater nose" sign. What is the most appropriate initial surgical management if conservative treatment with immobilization has failed?

. Triple arthrodesis
. Subtalar arthrodesis
. Resection of the coalition with extensor digitorum brevis interposition
. Talonavicular arthrodesis
. Medial displacement calcaneal osteotomy

Correct Answer & Explanation

. Resection of the coalition with extensor digitorum brevis interposition

Explanation

The "anteater nose" sign (elongated anterior process of the calcaneus) is pathognomonic for a calcaneonavicular coalition. After failed conservative treatment in an adolescent without severe arthritic changes, the gold standard is resection of the cartilaginous/bony bar with interposition of the EDB muscle or fat.

Question 4836

Topic: 8. Foot and Ankle

A 14-year-old boy presents with recurrent ankle sprains and rigid, painful flatfeet bilaterally. Clinical examination reveals absent subtalar motion. A computed tomography (CT) scan confirms a talocalcaneal coalition. Which specific articular facet is most commonly involved in this condition?

. Anterior facet
. Middle facet
. Posterior facet
. Lateral facet
. Medial facet

Correct Answer & Explanation

. Middle facet

Explanation

Talocalcaneal coalitions most frequently involve the middle facet of the subtalar joint. It often presents in early adolescence as the cartilaginous coalition ossifies and restricts hindfoot motion.

Question 4837

Topic: 8. Foot and Ankle

A 10-year-old boy who plays competitive soccer presents with bilateral posterior heel pain that is exacerbated by running. Examination shows point tenderness over the calcaneal insertion of the Achilles tendon and tight heel cords. Radiographs show increased sclerosis and fragmentation of the calcaneal apophysis. What is the most appropriate management?

. Surgical excision of the fragmented apophysis
. Corticosteroid injection into the retrocalcaneal bursa
. Below-knee non-weight-bearing cast for 6 weeks
. Heel cord stretching, heel cups, and activity modification
. MRI to rule out acute osteomyelitis

Correct Answer & Explanation

. Heel cord stretching, heel cups, and activity modification

Explanation

Sever's disease (calcaneal apophysitis) is a self-limiting traction apophysitis common in active, growing children. Management is purely conservative, consisting of Achilles stretching, heel cord lifts/cups, and temporary activity modification.

Question 4838

Topic: 8. Foot and Ankle

Figure 5 shows the oblique radiograph of a 13-year-old boy with a painful, rigid flat foot and recurrent ankle sprains. Conservative management has failed.

What is the most appropriate surgical treatment for this condition?

. Subtalar arthroereisis
. Medial displacement calcaneal osteotomy
. Resection of the coalition with extensor digitorum brevis interposition
. Triple arthrodesis
. Talonavicular arthrodesis

Correct Answer & Explanation

. Resection of the coalition with extensor digitorum brevis interposition

Explanation

The classic presentation of a calcaneonavicular coalition includes a rigid flatfoot and an 'anteater sign' on the oblique radiograph. For symptomatic cases failing conservative care, the gold standard treatment is resection of the coalition with interposition of the extensor digitorum brevis or fat.

Question 4839

Topic: 8. Foot and Ankle

A 2-month-old infant is undergoing treatment for right-sided idiopathic clubfoot using the Ponseti method. After four casts, the foot is fully abducted, but there is residual equinus of the ankle. During the planned percutaneous Achilles tenotomy, the surgeon must be careful to avoid injuring which of the following structures located immediately anterior and lateral to the tendon?

. Posterior tibial artery
. Sural nerve and lesser saphenous vein
. Tibial nerve
. Flexor hallucis longus
. Peroneal artery

Correct Answer & Explanation

. Sural nerve and lesser saphenous vein

Explanation

The sural nerve and lesser saphenous vein lie directly lateral and anterior to the Achilles tendon. They are at risk during percutaneous tenotomy if the scalpel blade is directed laterally.

Question 4840

Topic: Midfoot & Hindfoot

A 14-year-old boy presents with rigid flat feet and recurrent lateral ankle sprains. Examination reveals a lack of subtalar motion. Radiographs show a "C sign" on the lateral view. Which of the following represents the most likely anatomical location of the primary pathology?

. Calcaneonavicular joint
. Talonavicular joint
. Middle facet of the talocalcaneal joint
. Posterior facet of the talocalcaneal joint
. Cuboid-navicular joint

Correct Answer & Explanation

. Middle facet of the talocalcaneal joint

Explanation

The "C sign" on a lateral radiograph is highly indicative of a talocalcaneal coalition. This coalition most commonly involves the middle facet of the subtalar joint.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page